This book is a compilation of papers originally presented at a 2006
UK conference of the Society for Applied Philosophy. The theme was the
philosophy of public health. The editor's intent with this volume
is to back up his, "... claim that there is something that we can
coherently call a 'philosophy of public health'" (p. 3).
Read individually, the wide-ranging collection of essays on topics as
diverse as measuring the effects of public health activities, common
good vs. privacy considerations, and equipoise in public health research
does not obviously support Dawson's claim to coherence. Halfway
through the book this reviewer was thinking it a bit disjointed. By the
end of the volume, however, the essays taken as a whole come together to
make up pieces of a quilt that does indeed help to position public
health as, ".a rapidly growing area of applied ethics in its own
right." (p. 10).

An introduction by Dawson cogently sets the stage, with his lucid
arguments justifying a discussion of public health ethics connected to,
but separate from, the existing discussion of both health care ethics
and public administration ethics. For those who may be a bit rusty on
the history of philosophy, he also provides a primer on the basic
approaches to philosophical debate. The introduction by itself is a
valuable addition to a course on public health ethics.

King's essay on Luck, Risk and Prevention (pp. 27- 36) is a
particularly interesting in-depth examination of making hard choices to
balance the social good derived from proactive public health preventive
actions against the possible harm and problems resulting from preventive
measures. King uses the construct of luck-egalitarianism to lead the
reader through a lively discussion of luck v. choice as they affect
health status, then brings in the affects of government intervention
through public health policies intended to promote distributive
equality.

A discussion of justice and individual choice within the context of
public health policy is a frequent theme in other essays as well. For
example, Holm, in Global Concerns and Local Arguments: How a Localized
Bioethics may Perpetuate Injustice (pp. 63-72) considers the many
potential negative side effects of the current applications of global
bioethics. He presents the pros and cons of a universal approach to
public health policy decisions from an objectivist viewpoint, proposing
that a truly effective universal ethical framework prioritizes local
needs and concerns. He states that most globalization efforts are
insufficiently context sensitive, instead pushing, "specific
answers to specific ethical questions" rather than taking into
account the local sociocultural backdrop for the public health
intervention, thereby ignoring the potential harm we may inadvertently
cause.

Categories of Constraint and Avenues of Freedom: Proposing
Collective Agency for Addressing Problems of Obesity by Womack (pp.
133-143) also considers the difficult balance between private choice and
public health policy, focusing on the example of obesity. She addresses
the interplay between causation, choice, and human agency in regard to
obesity as they are balanced against the high social costs of this
problem. In particular, she discusses the complex causality of obesity
and the role of public health in controlling the presence of social cues
without violating our cherished Western culture beliefs regarding
individual rights. She argues, "Research that focuses on the
features of the social structures in the community, rather than merely
those of the individual, can better promote the general good of its
members." (p. 143).

A major part of the engagement with this book springs from the
current social context. It is interesting to get a mostly UK perspective
on topics such as achieving true social equity in public health
offerings and measuring the effects of public health programs while the
over-charged rhetoric of the debate on health care reform swirls through
the US. The specific examples in the essays make a fascinating
counterpoint to the sweeping, often inaccurate, generalizations about
other countries' health care systems in the daily news. The
emphasis on thinking about preventive care instead of acute care is a
particularly important lesson for those in the process of developing US
health care policy. A recurring theme in cost-savings discussion is
moving our system from an acute care to a preventive care emphasis.
Balancing individual choice and public good decisions is an emotional
undercurrent in that debate.

Virtually every private and nationalized health care system in the
world is currently under the microscope due to resource scarcity.
Therefore, the book's strengths lie in its timeliness as we grapple
with such important issues as individual choice v. cost-saving social
good while we consider health policy reform and the role of public
health. The book's weakness lies in the breadth of the topics
covered. The essay's far ranging ideas necessarily mean the
examination of each topic is just a taste of the issues rather than an
in-depth discussion. Generally, however, the examples provided are
engaging and the arguments presented are readable and directly relevant
to current debates. This book is a worthwhile tour of topics for the
policy analyst, public health professional or interested academic. It
would also be useful as dialogue-inspiring text in a graduate health
policy or public health ethics class.